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Old 04-25-2011
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X Ray X-ray in a case of limpy, painful leg

20 year old, limping on his right leg for a few months with constant pain. He suffered from a malignancy in the past. This is his X ray. What is the most likely cause of his leg pain and what is the malignancy he had before?

(NB.common pathology, common USMLE scenario, let's assess your knowledge!)

X-ray in a case of limpy, painful leg-kneexray.jpg
click image to enlarge
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Old 04-25-2011
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i think this is osteogenic sarcoma (osteosarcoma)

his leg pain is caused by the mass tht is causing a decrease in ROM.

are those sunray appearance with periosteal lifting? it definitely at the metaphysis area of the femur.

if this is indeed osteosarcoma then perhaps he had retinoblastoma previously and was treated with radiotherapy which now is causing osteosarcoma (yet another malignancy).

hmm..... any other opinions?

what's the answer?
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Agree with the post above
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I think this is a case of osteosarcoma and the malignancy in the past history is retinoblastoma. they are linked by the tumor suppressor gene Rb which is mutated in both cases. retinoblastoma may occur sooner and then osteosarcoma.
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confusing......
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Old 04-26-2011
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Default Osteosarcoma

Yes spot on! Osteosarcoma and retinobloastoma!

A sunburst pattern at the distal femur is characteristic of osteosarcoma, the most common primary bone malignancy that typically affects individuals 10 to 25 years of age.

Although most cases are idiopathic, there is an established molecular mechanism between retinoblastoma and osteosarcoma. Questions have arisen about the utility of screening patients with retinoblastoma for osteosarcoma occurrences. At present, however, screening is not performed. (source: usmle consult)
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